IRAQ WAR CLINICIAN GUIDE

Iraq War Clinician Guide 156 Appendix G
~ S ~ U M STRESSDISORDER
A ~ C 143
occasionally it is the result of a synthesis created by the patient-therapist
interactions.
ASSESSMENT
Mr. G. was assessed using multiple methods: a semistructured clinical
interview to evaluate the presence and absence of axis I and IIdisorders, a
structured clinical interview developed specifically to assess PTSD, self-report
questionnaires for PTSD and comorbid conditions, a clinicalinterview
with Mr. G's spouse, and a review of his medical records. In complicated
cases in which the diagnosis is unclear, psychophysiological assessment
and additional information from collateral sources may prove valuable.
The use of multiplemethods to assess F'TSD has severalbenefits. Individuals
may respond differently to different methods. For example, some individuals
may disclose more distress on a self-report questionnaire, while
others may feel more comfortable in the context of an interview and so
providemore accurate information. Theuse of multiple methods increases
the likelihood of capitalizing on the best method to obtain info~mation
from any given individual. In addition, each assessment method has
strengths and weaknesses. Clinical interviews rely more heavily on clinicianjudgment
than self-reportmeasures (a disadvantageof clinical interviews)but
allow more flexibilityin follow-up and clarification (an advantage
of clinical interviews). The use of multiple methods aids in balancing
the relative strengths and weaknesses of eachmethod
A clinical interview in the context of an assessment for PTSD focuses
on pretrauma functioning, information about the traumatic event(s),and
posttraunlatic functioning. Functioning prior to the trauma is critical in
order to determineposttrauma changesin functioning.Areasof pretrauma
functioning to assess include family composition and relationship with
family members, family history of psychopathology/substanceuse,pretrauma
stressors and their impacts (e.g., deaths, injuries, accidents, and
abuse), and educational, occupationa1,relationship(i.e., peers and dating),
legal, substance use, medical, and sexual histories.
When obtaining information about the client's trauma history, the
clinician is advised to proceed slowly and create a safe interpersonal
context for discussing sensitivematerial. A general framework for conducting
a clinical history containing braumatic material would focus on the
pretrauma period, the details of the traumaticevent, and the impact that
the event had on the individual across multiple domains of functioning.
Specifically assessment of the traumatic experience involves gathering
DEPARTMENT OF VETERANS AFFAIRS
NATIONAL CENTER FOR PTSD